[Morphologic and tomodensitometric comparative analysis of two cyclotocephalic newborns]

Two specimens of cyclotocephalic newborns, coming from museum collections, have been the subject of a comparative morphologic analysis. This one comprised an external examination and a CT scan exploration. If the craniofacial features were similar, one had a quasi-normal brain, while the second specimen displayed alobar holoprosencephaly. This observation relatively surprising is discussed in the light of current knowledge on the developmental genetics of this family of malformations.

Antenatal diagnosis of twin-reversed arterial perfusion sequence (acardiac amorphous) in a triplet pregnancy: case report

Acardiac twinning is the most extreme form of twin-twin transfusion syndrome occurring in monzygotic twin pregnancies with monochorionic placentation. A case of acardiac amorphous foetus, occurring in association with spontaneously conceived triplet pregnancy, diagnosed on ultrasound in early second trimester is described and its antenatal management and brief review of literature discussed.

Epignathus: always a simple teratoma? Report of an exceptional case with two additional fetiforme bodies

We report on a case of a fetal epignathus combined with two fetus-like structures resembling acardius acranius. The anomaly was detected at 23 weeks of gestation and led to termination of pregnancy at 24 weeks. This is the first description of epignathus with parasitic fetuses detected prenatally. It shows that the boundary between fetal teratoma and multiple pregnancy in special cases may be difficult to define.

Computed tomography of a cyclotocephalic neonate

Cyclotocephaly is a very rare malformative lethal condition which associates otocephaly (extreme hypoplasia of the mandibular arch with agnathia) and cyclopy with proboscis. The head of a cyclotocephalic neonate from our Museum of Anatomy and Embryology was examined using computed tomography (CT). Cutaneous and osseous three-dimensional reformations were performed. Severe bony malformations were observed. A single orbital cavity was surrounded by a cartilaginous proboscis and a median fusion of maxillae, temporal and zygomatic bones. The single orbital cavity contained both paramedial eyeballs (synophthalmia). The external auditory meati and the ear pinnae were also parasagittal. No oral cavity and mandible were observed. Despite the poor conservation state of the brain, lobar holoprosencephaly was suspected. The mesencephalon and pituitary gland were absent. This exercise could lead to optimizing ultrasonographic prenatal diagnosis.

Prenatal sonographic diagnosis of a twinning epigastric heteropagus

Epigastric heteropagus is a rare type of conjoined twinning which results from an ischemic atrophy of one fetus at an early stage of gestation. We present what we believe to be the first case diagnosed antenatally at 22 weeks' gestation. The pelvis and lower limbs of the ischemic fetus (the parasite) were attached to the epigastrium of the well-developed fetus (the autosite), which had a small omphalocele. Antenatal sonography provided an accurate diagnosis, enabling unnecessary abortion to be avoided.

[Acardius acephalus. Description of a case]

We report a case of twin gestation (monochorionic-diamniotic) in which one of the twins was acardiac and acephalic. His co-twin suffered infectious, hematological and neurological complications. This condition belongs to the broad spectrum of twin-to-twin transfusion syndrome (TTTS) and is observed in monozygous pregnancies in which the vascular systems of the fetuses are connected. The severity of this syndrome depends on the type of anastomoses and the timing of their establishment. Circulation is accomplished by the heart of the more perfect twin ("pump twin") who is at risk for heart failure. The recipient twin may display severe and sometimes lethal anomalies, such as acardia or acephalus. In some cases a prior situation such as a single umbilical artery or chromosomal anomaly in the acardiac twin may be found. Early diagnosis is essential to formulate a plan of management focused on the normal twin.

Treatment of acardiac twinning

BACKGROUND

The twin reversed-arterial-perfusion sequence is a complication of monochorionic twin pregnancies characterized by the hemodynamic dependence of a "recipient" twin from a "pump" twin. The recipient twin exhibits lethal abnormalities including acardia and acephaly. The pump twin has a mortality rate of 50% as a result of high-output heart failure.

CASE

The blood supply to an acardiac-acephalus twin was interrupted at 24 weeks' gestation using endoscopic laser coagulation. The co-twin was delivered at 35 weeks and had an uneventful neonatal course following correction of a persistent patent ductus arteriosus. Review of the literature reveals 22 cases of acardiac twinning treated with invasive procedures, seven of them using endoscopic laser coagulation. Pump twin mortality with fetal surgery was 13.6% in comparison with 50% mortality with expectant management (P < .001).

CONCLUSION

Fetal surgery is the best available treatment for acardiac twinning. Endoscopic laser coagulation at or before 24 weeks and endoscopic or sonographic guided umbilical cord ligation after this gestational age seem to be the best treatments for this condition.

Severe brain and limb defects with possible autosomal recessive inheritance: a series of six cases and review of the literature

Six fetuses with normal chromosomes were found to have severe craniofacial, limb, and visceral malformations during the second trimester of pregnancy. Two of these fetuses were monozygotic twins while a third one had a healthy dizygotic twin brother. A case with familial recurrence was also observed. Autopsy and skeletal radiographs suggested several diagnoses such as neural tube defect with limb defects or XK aprosencephaly. The development of these severe conditions in monozygotic twins and familial recurrence emphasize the difficulties of genetic counseling in such situations. These cases may suggest autosomal recessive inheritance.

Skeletal deformities of acardius anceps: the gross and imaging features

A morphology based imaging review is presented of the characteristic skeletal deformities associated with acardius anceps in three acardiac twins. These fetuses demonstrated poorly developed skulls, limb reduction defects, and phocomelia of the upper limbs, as well as narrow thoracic cages with or without the complete development of ribs, clavicles, scapulae, and cervical, thoracic, or lumbar vertebrae. However, their lower limbs and pelvic girdles were almost normal. The authors conclude that skeletal development is likely to be jeopardized in the area adjacent to the heart and in the cephalic portion of the body in fetuses with acardius anceps, and suggest vascular deficiency and hypoperfusion as pathogenetic mechanisms in this type of skeletal deformity.

[Twin pregnancy with acephalic acardiac fetus. Anatomo-clinical description of 2 cases]

Two cases are reported of acardiac-acephalic twin pregnancy, a rare malformation of multiple gestations with large placental vascular anastomosis. In both cases, respectively 25 and 30 weeks of gestation, ultrasound scan revealed a first normal fetus and a nonviable twin without cardiac activity and head, but increasing in size at serial scans. The authors describe the obstetric management, the Rx details and the anatomo-pathological findings emphasizing the analogies between the two acardiac fetuses.

Abdominal mass: "fetus in fetu"

A female newborn presented a mass in the left upper abdominal quadrant. It was removed by surgery and contained two independent fetuses. Dissection and radiological study of the fetuses showed an axial skeleton and long bones. It corresponds to the generally recognized diagnostic criteria of fetus in fetu.

[Pygomelus]

With an anatomical case and a clinical case, the authors describe the pygomelus, a very rare monstruosity. Legend and reality are often mixed in the description of literature. It is difficult to classify this monstruosity either in the simple monster or in the twin monsters.

Neu-Laxova syndrome: a case report

Neu-Laxova syndrome is a rare form of congenital malformation characterized by intrauterine growth retardation, microcephaly with bizarre facial features, short neck, apparent edema, scaly skin, and perinatal death. Chromosomal analysis in reported cases has revealed a normal karyotype, and an autosomal recessive transmission has been postulated. We present a case of Neu-Laxova syndrome. The pathologic features and the prenatal radiographic appearance are described.

[A case of diprosopus in the cat]

A case of diprosopus in a spontaneously delivered live-born kitten is reported. All facial components were completely duplicated. Fusion of the skulls had occurred in the temporal region; a single ear was present at the site of fusion. Additional defects were a cleft lip in one face and cleft palates in both faces. The cerebral hemispheres and arterior portions of the brain stem were completely duplicated, whereas the cerebellum and caudal brain stem were partially duplicated. The pathogenesis and aetiology are discussed. It is believed that disprosopus originates during the (pre)gastrulation stage of embryonic development, either by coalescence of two embryonic fields following a double process of gastrulation or by bifurcation of the axial mesoderm during a single gastrulation.

Antenatal ultrasonic evaluation of acardiac monsters

Acardiac monster represents a rare but serious complication of monozygotic twin pregnancy. Antenatal recognition is important because of accompanying obstetrical problems, including polyhydramnios, dystocia, and uterine rupture. While pathologic findings are varied, characteristic sonographic findings allow accurate prenatal diagnosis. Acardia must be distinguished from sacrococcygeal teratoma, omphalocele and macerated fetus.

The acardiac monster

Two cases of acardiac fetuses are presented. Pathological data in 61 cases are tabulated. Cliassification, terminology and patho-physiological findings are discussed. The Acardiac Monster is a form of monozygotic multiple gestation lacking a physiological heart and resulting in a bizarre fetal malformation which is sustained in utero by parasitic anastomoses to the circulation of a normal twin fetus. The precise etiology of this phenomenon is still obscure and suggestions are made for the future evaluation of the acardiac fetus.

[Case report of a twin-monster, dicephalus, dibrachius (author's transl)]

The dicephalus dibrachius twin malformation is a rare developmental anomaly. Spontaeous birth is impossible. Prenatal diagnosis of this condition is difficult though essential to prevent danger to the life of the mother. Radiological examination before birth is necessary. Auscultation and bimanual examination only may lead to the erroneous diagnosis of a twin pregnancy, as in this case, where in the end a cesarean sectionwas performed because unseparated twins were suspected.

[Cloverleaf cranial anomaly. Report of 2 cases]

Two cases of cloverleaf anomaly are presented. The first one was associated to complete spina bifida and flexion of elbows and knees, and the second to syndactyly of 3rd and 4th fingers of both hands; short, broad and swerved thumbs; rudimentary bilateral preaxial polydactyly, pes varus with broad first metatarsus. Authors agree with the opinion that this anomaly is a sign which may occur in disorders with early craniosynostosis and emphasise the importance of the identification of the underlying disorder because, knowing its pattern of inheritance, a proper genetic advice may be rendered. The neurosurgical procedure can be useful for cosmetic purposes and for encephalitic decompression, but the results are somewhat unsatisfactory because of the severity of the defect.

Case Report: epignathus-clinical, radiologic, and pathologic considerations

In retrospect, a diagram could hace been made from the antenatal radiological examination of the case of epignathus presented here. The features of the epignathus are considered with respect to antenatal diagnosis and subsequent reparative surgery. Specific features such as axial organization, maturity of all tissues, and identical ossification points between host and parasite-all of which are evident in this case-favor the malformative origin of epignathi, thus distinguishing them from teratomata.

Fetus-in-fetu: An ususual cause for abdominal mass in infancy

Fetus-in-fetu is an unusual cause of retroperitoneal abdominal mass in infants, which most likely arises from inclusion of a monozygotic, diamniotic twin. This entity is distinguished from teratoma by its embryological origin, its unusual location in the retroperitoneal space, its invariable benignity, and by the presence of vertebral organization with limb buds and well-developed organ systems. Diagnosis is made radiographically by the finding of a diminutive vertebral column on a plain abdominal film. The treatment of choice is total excision with special attention being given to the fetus' blood supply which may be directly from the host's superior mesenteric vessels. A well-documented example of this unusual entity that occurred in a six-week old infant male is presented.